Nurse-led implementation of ETAT+ is associated with reduced mortality in a children’s hospital in Freetown, Sierra Leone

Hands, Sandra; Verriotis, Madeleine; Mustapha, Ayeshatu; Ragab, Hany; Hands, Christopher

doi:10.1080/20469047.2020.1713610

Cited by 9 publications

(12 citation statements)

References 10 publications

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“…There were further improvements in timing over three months in 2018 despite no further changes being made to layout or flow. This pattern is similar to that observed in the Freetown pilot data and may relate to ongoing improvements in teamwork [ 20 ].…”

Section: Discussionsupporting

confidence: 82%

“…Following a successful pilot in 2015-16 at Ola During Children’s Hospital (ODCH) in Freetown [ 20 ], the MoHS incorporated ETAT+ as part of its national child mortality reduction strategy [ 21 ]. The five-day ETAT+ course was adapted to be delivered over three months using classroom teaching, skills sessions, simulation and small group discussions, followed by three months’ in-situ practice mentoring with trainees ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Assessment of triage quality was performed by the mentor teams over a week at the beginning and the end of the six-month intervention in 2017, and at the beginning and after three months in 2018. The method for making these observations has been described previously, [ 20 ] and involved the mentor team logging the arrival time of each patient, as well as the time their first treatment was administered. Data for each hospital were logged in an Excel spreadsheet by the mentor team and collated by the programme management team in Freetown.…”

Section: Methodsmentioning

confidence: 99%

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Emergency Triage Assessment and Treatment Plus (ETAT+): adapting training to strengthen quality improvement and task-sharing in emergency paediatric care in Sierra Leone

Hands

Verriotis³

et al. 2021

J Glob Health

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Background Over the past 25 years Sierra Leone has made progress in reducing maternal and child mortality, but the burden of preventable paediatric deaths remains high. Further progress towards achieving the Sustainable Development Goals will require greater strengthening of the health care system, including hospital care for perinatal and paediatric conditions. Emergency Triage Assessment and Treatment Plus (ETAT+) may offer a useful tool. Methods The five-day ETAT+ course was adapted as a six-month programme of in-situ training and mentoring integrated with patient flow and service delivery improvements in 14 regional and district government hospitals across the country. Nurses were trained to carry out the initial resuscitation and assessment of the sick paediatric patient, and to administer the first dose of medication per protocol. The course was for all clinical staff; most participants were nurses. Results The intervention was associated with an improvement in the quality of paediatric care and a reduction in mortality. In 2017 mortality decreased by 33.1%, from 14.5% at baseline to 9.7% after six months of the intervention. Mortality at the start of the 2018 intervention was 8.5% and reduced over six months to 6.5%. Care quality indicators showed improvement across the two intervention periods, with some evidence of sustained effect. Conclusions These results suggest that adapted ETAT+ training with in-situ mentoring alongside improved patient flow and service delivery supports improvements in the quality of paediatric care in Sierra Leonean hospitals. ETAT+ may provide an affordable framework for improving the quality of secondary paediatric care in Sierra Leone and a model of nurse-led resuscitation may allow for prompt and timely emergency paediatric care in Sierra Leonean hospitals where there are fewer physicians and other resources for care.

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Section: Discussionsupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Emergency Triage Assessment and Treatment Plus (ETAT+): adapting training to strengthen quality improvement and task-sharing in emergency paediatric care in Sierra Leone

Hands

Verriotis³

et al. 2021

J Glob Health

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“…In several resource-limited settings, ETAT+ training has been adapted to match specific contexts while maintaining essential elements of paediatric emergency and critical care as outlined in WHO guidelines. [27][28][29][30] Implementing ETAT principles can contribute to substantial reduction of paediatric hospital mortality in resource-limited settings. [17,[28][29][30][31] Results of this evaluation suggest that perceptions of learning experiences and training methods were similar among health professionals with different clinical backgrounds such as general practitioners, nurses and midwives.…”

Section: Articlementioning

confidence: 99%

“…[27][28][29][30] Implementing ETAT principles can contribute to substantial reduction of paediatric hospital mortality in resource-limited settings. [17,[28][29][30][31] Results of this evaluation suggest that perceptions of learning experiences and training methods were similar among health professionals with different clinical backgrounds such as general practitioners, nurses and midwives. However, results also indicate that certain elements in the preparation and delivery of ETAT+ training need to be adapted (e.g.…”

Section: Articlementioning

confidence: 99%

A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar

Galatsch

Lang

Noa

et al. 2022

South Afr J Crit Care

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Background. Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted in December 2019 at the University Hospital Mahajanga. Objective. This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved their learning objectives.Methods. In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities. Results. Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants’ needs and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multi- disciplinary efforts are needed to advance ETAT+ implementation in Madagascar.Conclusions. Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to contexts in Madagascar.

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The Sierra Leone National ETAT+ Programme: Delivering Nurse-Led Emergency Paediatric Care

Hands

Hands²,

Bangura³

et al. 2023

Worldwide Successful Pediatric Nurse-Led Models of Care

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Nurse-led implementation of ETAT+ is associated with reduced mortality in a children’s hospital in Freetown, Sierra Leone

Cited by 9 publications

References 10 publications

Emergency Triage Assessment and Treatment Plus (ETAT+): adapting training to strengthen quality improvement and task-sharing in emergency paediatric care in Sierra Leone

Emergency Triage Assessment and Treatment Plus (ETAT+): adapting training to strengthen quality improvement and task-sharing in emergency paediatric care in Sierra Leone

A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar

The Sierra Leone National ETAT+ Programme: Delivering Nurse-Led Emergency Paediatric Care

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